Viramontes Terry S, Truong Havan, Linnebur Sunny A
King Soopers Pharmacy, Denver, Colorado, USA.
Consult Pharm. 2016 Mar;31(3):139-50. doi: 10.4140/TCP.n.2016.139.
To describe the prevalence of hyponatremia in older adults related to antidepressive agents and identify potential alternative options in older adults with a low-baseline serum sodium concentration and/or when a patient has experienced hyponatremia as a result of taking an antidepressant.
A PubMed search was conducted on November 10, 2015. Search terms included: antidepressive agents, antidepressive agents second-generation, bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, hyponatremia, milnacipran, mirtazapine, paroxetine, reboxetine, syndrome of inappropriate antidiuretic hormone, sertraline, trazodone, venlafaxine, and vilazodone. Filters included English language. A search of product labeling was also conducted.
Out of 363 results, 124 publications were identified and reviewed along with 11 additional references. Publications were chosen based on relevance to the review: case reports of patients 60 years of age or older or clinical investigations of the association between hyponatremia and antidepressants in older adults.
Hyponatremia was counted as an adverse effect if an antidepressant was the likely cause of hyponatremia, and hyponatremia was resolved after withdrawal.
Antidepressant-induced hyponatremia in older adults is fairly common. Selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, and mirtazapine were implicated in the majority of the case reports and clinical studies evaluating older adults. Bupropion, trazodone, and tricyclic antidepressants were implicated less often in the same literature.
Given its unique mechanism of action, bupropion may be the most appropriate antidepressant for older adults at risk for antidepressant-induced hyponatremia.
描述老年人中与抗抑郁药相关的低钠血症患病率，并确定基线血清钠浓度低的老年人和/或患者因服用抗抑郁药而出现低钠血症时的潜在替代选择。
2015年11月10日进行了PubMed搜索。搜索词包括：抗抑郁药、第二代抗抑郁药、安非他酮、西酞普兰、去甲文拉法辛、度洛西汀、艾司西酞普兰、氟西汀、氟伏沙明、低钠血症、米那普明、米氮平、帕罗西汀、瑞波西汀、抗利尿激素分泌异常综合征、舍曲林、曲唑酮、文拉法辛和维拉唑酮。筛选条件包括英文文献。还对产品标签进行了搜索。
在363条结果中，识别并审查了124篇出版物以及另外11篇参考文献。根据与综述的相关性选择出版物：60岁及以上患者的病例报告或老年人低钠血症与抗抑郁药之间关联的临床研究。
如果抗抑郁药可能是低钠血症的原因且停药后低钠血症得到缓解，则将低钠血症计为不良反应。
老年人中抗抑郁药引起的低钠血症相当常见。在大多数评估老年人的病例报告和临床研究中，选择性5-羟色胺再摄取抑制剂、5-羟色胺/去甲肾上腺素再摄取抑制剂和米氮平与低钠血症有关。在同一文献中，安非他酮、曲唑酮和三环类抗抑郁药与低钠血症的关联较少。
鉴于其独特的作用机制，安非他酮可能是有抗抑郁药引起低钠血症风险的老年人最合适的抗抑郁药。
